Musculoskeletal Science and Practice 33 (2018) 61–66

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Musculoskeletal Science and Practice

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Original article

Tactile acuity is reduced in people with chronic neck pain T

a,b,c,d,∗ c a,b
Daniel S. Harvie , Grace Edmond-Hank , Ashley D. Smith
a
Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, University of Queensland, Brisbane, Australia
b
School of Allied Health Sciences, Griffith University, Gold Coast, Australia
c
Menzies Health Institute QLD, Griffith University, Gold Coast, Australia
d
Bond Institute for Health & Sport, Bond University, Robina, Australia

ARTICLE INFO ABSTRACT

Keywords: Background: Tactile acuity deficits have been demonstrated in a range of persistent pain conditions and may
Tactile acuity reflect underlying cortical re-organisation.
Musculoskeletal pain Objective: This study aimed to determine whether tactile acuity is impaired in people with chronic neck pain
Neck pain relative to controls, and whether deficits relate to pain location, duration and intensity.
Chronic pain
Methods: In this cross-sectional study, 20 people with chronic neck pain (5 idiopathic neck pain; 15 whiplash-
Whiplash
associated disorder) and 20 pain-free controls underwent two-point discrimination (TPD) testing at the neck,
Two-point discrimination
Somatosensory precision back and arm, and point-to-point (PTP) and graphesthesia tests of tactile acuity at the neck and arm.
Results: Linear mixed effects models demonstrated a significant group*body region interaction for TPD,
Graphesthesia and PTP tests (Ps < 0.001), with post hoc tests showing impaired TPD in people with neck pain
relative to controls at the neck, low back, and arm (P ≤ 0.001). Graphesthesia and PTP was also impaired at the
neck (P < 0.001) but not the arm (P ≥ 0.48). TPD correlated with intensity and duration of pain (Pearson's
r = 0.48, P < 0.05; Pearson's r = 0.77, P < 0.01). There was no sig difference between the two neck pain
groups for any tactile acuity measure (TPD: P = 0.054; Graphesthesia; P = 0.67; Point to Point: P = 0.77),
however, low power limited confidence in this comparison.
Conclusion: People with chronic neck pain demonstrated tactile acuity deficits in painful and non-painful regions
when measured using the TPD test, with the magnitude of deficits appearing greatest at the neck. The study also
revealed a positive relationship between TPD and pain intensity/duration, further supporting the main study
finding.

1. Introduction normalize S1 reorganization, and reduce pain (Flor et al., 2001;

The precise ability to sense touch, known as tactile acuity, appears
to be reduced in some chronic pain conditions (Catley et al., 2014).
Since these impairments are not the result of diminished tactile detec-
tion (Moseley, 2008; Wand et al., 2010) or transmission (van Rijn et al.,
2009), deficits are thought to be a manifestation of altered somato-
sensory processing. This is supported by the observation that tactile
acuity deficits coincide with changes in functional organisation of the
somatosensory (S1) cortex, observable using functional Magnetic Re-
sonance Imaging (fMRI), in a range of chronic pain conditions, in-
cluding: complex regional pain syndrome (Juottonen et al., 2002),
carpal tunnel syndrome (Tecchio et al., 2002), phantom limb pain (Flor
et al., 1995), and low back pain (Flor et al., 1997). Since tactile acuity
depends on somatosensory function, tactile acuity tests such as the two-
point discrimination test (TPD) are purported to provide a window into
S1 function. Early studies suggest tactile training approaches might
Moseley et al., 2008a; Pleger et al., 2005), which has driven further
interest in tactile acuity testing which in the future may be useful to
identifying patients appropriate for such treatment.
To date, tactile acuity and cortical reorganization has only been
examined in a limited number of conditions (Catley et al., 2014). No
studies to date have investigated tactile acuity in people with chronic
neck pain (CNP), which is surprising given that CNP stands as one of the
greatest causes of disability world-wide (Vos et al., 2015), and a need to
investigate tactile acuity at the neck has been recently been highlighted
(Luedtke and Adamczyk, 2017). Investigating signs of central adapta-
tion is also of particular interest given the limited evidence to support
the assumption that tissue damage or disease causes chronic neck pain.
For example, tissue abnormalities often blamed for pain occur at similar
rates in people without pain (Anderson et al., 2012; Jensen et al.,
1994). Notwithstanding the limitations of imaging techniques, tissue
factors at best provide an incomplete picture of the cause of ongoing

∗
Corresponding author. Bond University, Robina, QLD 4226, Australia.
E-mail address: dharvie@bond.edu.au (D.S. Harvie).

https://doi.org/10.1016/j.msksp.2017.11.009
Received 11 August 2017; Received in revised form 2 November 2017; Accepted 18 November 2017
2468-7812/ © 2017 Elsevier Ltd. All rights reserved.
D.S. Harvie et al. Musculoskeletal Science and Practice 33 (2018) 61–66

neck pain (Curatolo et al., 2011). Notably, while central adaptations

may be implicated across chronic neck pain conditions, whiplash as-
sociated disorder (WAD) have frequently been associated with greater
signs of central dysfunction relative to idiopathic neck pain (Scott et al.,
2005).
We aimed to determine whether tactile acuity is impaired in people
with CNP relative to controls, whether deficits are localised to the
painful body region, and whether deficits relate to duration and in-
tensity of pain. We also aimed to investigate if tactile acuity was in-
fluenced by the origin of neck pain (e.g. whiplash injury vs. idiopathic
onset). We hypothesised that tactile acuity would be impaired in people
with CNP, only at the site of pain, and that deficits would correlate with
pain intensity and duration, and be greater in WAD. Further, we con-
ducted these investigations using a range of tactile acuity testing
methods, since distinct tests are likely to involve distinct central and
peripheral mechanisms.

2. Methods

2.1. Participants

People with CNP were recruited through a database within the

Recover Injury Research Centre and through a local physiotherapy
practice between June and December 2016. An age and gender mat-
ched control ( ± 5 years) was recruited for each CNP participant using
word of mouth and campus media. All participants were between the
ages of 18–65 years. Participants with daily, chronic (> 3 months)
idiopathic or traumatic neck pain were eligible for inclusion in the
study. Allocation to WAD or idiopathic CNP subgroup was made by a
physiotherapist based on the history of the presenting complaint and
whether the onset was insidious/non-traumatic (idiopathic) or invol-
ving a traumatic whiplash-type mechanism (WAD). People with po-
tential neurological deficit (symptoms or signs) were excluded, in-
cluding those with head injuries, strokes and diabetes. Co-morbid
musculoskeletal complaints including lower back and hand pain were
recorded and accounted for in statistical analyses. Control group par-
Fig. 1. Visual representation of the location and equipment for each tactile acuity test at
ticipants were excluded on the basis of history of chronic pain, current
each location. The tools depicted represent the Vernier Digital Sliding Caliper, Von Frey
pain, or presence of neurological disorder or neurological symptoms/ filament and fine tipped pen.
signs such as dysesthesia. Age, height and weight were collected as
these factors are purported to have a small impact on tactile acuity
(Lourens, 2014; Falling and Mani, 2016). Duration of pain was self- provide two simultaneous tactile stimuli. For the spinal measures, the
reported and average intensity of pain over the last week was quantified caliper was aligned vertically 15 mm lateral to the spinous processes of
using the visual analogue scale within the McGill pain questionnaire C7 or L4 in the neck and low back respectively. At the arm, the caliper
(Melzack, 1987) and the Neck Disability Index was used to categorise was aligned with the long axis of the dorsal forearm 15 mm proximal to
disability as mild (< 28%), moderate (30–48%), severe (50–68%) or the wrist joint-line. Assessment commenced with the two-points at a
complete (> 70%) (Vernon and Mior, 1991). Ethics approval was 20 mm separation, and was increased by 2 mm increments until the
granted by the Griffith University Human Research Ethics Committee participant reported feeling two points of contact. If two distinct points
(2016/168). All data was collected in Recover Injury Research labora- were perceived in three consecutive trials this value was recorded. A
tory and Allsports physiotherapy clinic between June and October of series of three ascending and descending assessments were performed,
2016 by a trained research assistant who was blind to study aims and with the mean of the six values used for analyses. TPD has been shown
hypotheses, but not to group allocation. to have excellent intra-rater reliability at the neck (ICC = 0.85)23.

2.2. Procedures 2.2.2. Point-to-point

Participants lay prone on a height adjustable treatment table, with
their neck, low back and arm exposed. A pen was used to mark the
anatomical reference points for the tests on the participant's dominant
side (Fig. 1). If the participant did not have neck pain on their dominant
side, testing was performed on the painful side (n = 5). Tests were
performed by the same examiner (research assistant) in a standardised
order (TPD, PTP then Graphesthesia).
2.2.1. Two-point discrimination
TPD was assessed using an established protocol (Catley et al., 2013).
Briefly, a sliding two-point Vernier Calliper (Fig. 1) with digital mea-
surement was placed under its own weight on the participant's skin, to
A testing protocol designed for assessment of PTP in the lumbar
spine was previously adapted for use in the cervical region (Adamczyk
et al., 2016). The methodology adapted for the cervical region and used
in this study was previously described and shown to have good intra-
rater reliability (ICC = 0.60) (Harvie et al., 2017). Participants held a
fine tip pen in their dominant hand positioned in contact with their
occiput. A Von-Frey filament (6.45 g) was applied by the experimenter
for 1 s per trial three-times at each of the three locations in pre-ran-
domised order (Fig. 1). Participants were instructed to use the pen tip to
mark the location of perceived touch as accurately as possible. The
score for each trial was the absolute error (mm) between the actual and
perceived point of touch, measured using a mechanical sliding calliper.
The mean of nine trials entered the analysis. For the forearm,

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D.S. Harvie et al. Musculoskeletal Science and Practice 33 (2018) 61–66

participants were sitting in a comfortable position, with their right
forearm placed on a table in front of them and their head turned to the
left and eyes closed. The dorsal aspect of the wrist joint-line was pal-
pated and marked. Two more points were marked on the dorsal forearm
30 mm and 60 mm proximal to the first mark. A pen was then given a
pen in their non-test hand which was placed at the mid-forearm of their
test side. The Von-Frey filament was then applied to each of the three
locations in pre-randomised order and scores recorded as previously
described for the neck.
2.2.3. Graphesthesia
A testing protocol designed for assessment of Graphesthesia in the
lumbar spine was adapted for use in the cervical region (Wand et al.,
2010). Twenty alphabetic letters were traced sequentially on the par-
ticipant's cervical region (Fig. 1) according to a pre-randomised order
using the rounded end of a pencil. Participants were asked to verbally
identify each letter drawn while the experimenter recorded and each
response as correct or incorrect and determined the final score (number
correct/20). Graphesthesia has been shown to have fair intra-rater re-
liability at the neck (ICC = 0.48) (Harvie et al., 2017). For the forearm,
participants were sitting in a comfortable position, with their right
forearm placed on a table in front of them. A circle that was 2 cm in
diameter was then traced proximal to, and with the bottom edge in
contact with, the wrist joint line (see Fig. 1). Whilst the participant was
turned away and with eyes closed the twenty alphabetic letters were
traced and participant responses recorded as above.
2.3. Statistical analysis
analysis comparing tactile acuity between these groups using a two-
tailed t-test for each of the tactile acuity tests.
Our sample size was calculated with respect to previous research
(Luomajoki and Moseley, 2011) demonstrating statistically large tactile
acuity deficits in people with low back pain (Cohen's d > 0.8). The
sample size was targeted to achieve 80% power with alpha set at the
standard p = 0.05.
Prior to study commencement experimenter reliability (for the pri-
mary region of interest – the neck) was tested using ten healthy in-
dividuals who underwent test-retest measures 30-min apart. Cronbach's
alpha analysis was then performed to quantify reliability. A high degree
of repeatability was shown for Two-point discrimination (0.83), Point-
to-point (0.60) and Graphesthesia (0.51).
3. Results
3.1. Participant characteristics
Forty subjects including 20 people with CNP (10 females) and 20
controls (10 females) were recruited. There were no significant differ-
ences between groups (CNP vs. controls) for age, BMI, height or weight
(all P > 0.05). People with CNP presented with mild (n = 5), mod-
erate (n = 8), severe (n = 6), and complete (n = 1) disability, and pain
above 30/100 (n = 17/20). CNP was idiopathic (n = 5/20), or whi-
plash associated (n = 15/20) (Table 1). Within the CNP group twelve
people had both right and left sided neck pain, five had only left sided
neck pain, and three had right sided neck pain, while four people also
had co-morbid lower back pain.

Data was analysed using IBM SPSS Statistics for Windows, Version
4. Tactile acuity deficits
23.0 (Armonk, NY) by an experienced researcher who was blind to
group allocation. Data normality was confirmed using box plots, scatter
4.1. Two-point discrimination
plots and Kolmogrov Smirnov tests. Descriptive statistics examined
group differences for demographic variables and a random intercept
There was a significant interaction between group and region in-
model was constructed to evaluate the effects of group (CNP vs. control)
dicating that there was a difference in TPD between groups for the neck,
on tactile acuity for each body region (neck vs. low back vs. arm [for
low back and arm regions (group*region: F2,34 = 14.2, P < 0.001)
TPD]; neck vs. arm [for PTP and Graphesthesia]).
(Fig. 2). Pairwise comparison demonstrated that TPD thresholds were
The fixed effects of group (CNP vs. control) and region (neck vs. low
higher in people with CNP compared to controls at the neck (M
back vs. arm; or neck vs. arm) were included in the respective models.
(SD) = 64 (15) mm vs. 38 (5) mm, P < 0.001, d = 2.4), low back (52
Interactive effects of group with region (group*region) were examined.
(6) vs. 47 (5) mm, P = 0.003, d = 1.1), and arm (24 (4) vs. 17 (7),
Where significant effects of fixed factors were observed, pairwise
P < 0.001, d = 1.3).
comparisons using Bonferroni corrections for multiple comparisons
were performed to investigate specific between-group or between-re-
gion differences. Cohen's d effect sizes were also calculated to assist 4.2. Effect of body region
observation of effect size.
The magnitude of the deficits at the neck vs. the arm and low back Although the greater mean differences and effect sizes at the neck
were compared by standardising each participants TPD threshold score, suggested a greater magnitude of TPD deficit, it was unsure whether the
at each body site, to a percentage relative to the mean control group
score at the corresponding site. One-way ANOVA was used to analyse Table 1
Patient characteristics.
the effect of body region (neck vs. low back vs. arm) on percentage of
TPD difference relative to controls. Variable Control mean (SD) CNP mean (SD)
P-values less than 0.05 were considered significant for all the above
analyses. Where CNP subjects showed co-morbid pain at the control Age (years) 32.7 (17.7) 36.9 (13.4)
Height (cm) 172.9 (11.7) 171.9 (10.1)
sites (lower back or hand) tactile acuity data from the associated body
Weight (Kg) 78.9 (19.1) 79.2 (15.7)
site was excluded from the analysis. This enabled the effect of CNP on Body Mass Index 26.3 (5.3) 26.7 (4.4)
tactile acuity at non-neck related sites to be analysed without the Pain Intensity (/100) n/a 45.3 (20.4)
confounding effect of pain at the comparison locations. Pain Duration (years) n/a 7.5 (7.1)
Pearson's correlations were used to investigate the relationship be- Gender (% female) 50% 50%
Paracetamol/Ibuprofen 2/20 7/20
tween pain intensity, pain duration and tactile acuity at the neck. As Central analgesic 0/20 3/20
there were significant relationships demonstrated between pain in- Other medication 2/20 2/20
tensity/duration and TPD, the above models for TPD were repeated in Idiopathic:Traumatic n/a 5:15
the sample without low back pain to ensure that presence of low back Neck Disability Index n/a Mild – 5
Moderate – 8
pain did not confound results.
Severe – 6
Finally, since WAD is reportedly associated with greater signs of Complete – 1
central sensory dysfunction, such as cold hyperalgesia (Scott et al.,
2005), relative to idiopathic neck pain, we performed a subgroup CNP – Chronic Neck Pain; SD – Standard Deviation.
∗

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D.S. Harvie et al. Musculoskeletal Science and Practice 33 (2018) 61–66

Fig. 2. Two-point discrimination thresholds for each group at the neck, low back and
arm. Error bars denote 95% Confidence Intervals.

relative deficit in TPD was different between body regions. One-way

ANOVA demonstrated a significant effect of region on the percentage
difference relative to controls (F2,59 = 5.45, P = 0.007). Bonferroni
corrected pairwise comparisons demonstrated that relative TPD deficits
Fig. 3. Point-to-point test scores for each group at the neck and arm. Error bars denote
were greater in the neck (M(SD) = 68 (39)% compared to the low back 95% Confidence Intervals.
(12 (12)%, P < 0.01), and in the neck relative to the arm (43 (25)%,
P = 0.01).

4.3. Point-to-point

There was a significant interaction between group and region in-

dicating that there was a difference in PTP between groups for the neck
and arm regions (group*region: F1,39.9 = 77.4, p < 0.001) (Fig. 3).
Pairwise comparison demonstrated that PTP was higher at the neck in
people with CNP relative to controls ((M(SD) = 18 (2) mm) vs. 10 (2)
mm, P < 0.001, d = 4.0). PTP was not different at the arm in people
with CNP relative to controls (M(SD) = 9 (2) mm) vs.10 (2) mm,
P = 0.48, d = 0.5).

4.4. Graphesthesia

There was a significant interaction between group and region in-

dicating that there was a difference in Graphesthesia between groups
for the neck and arm regions (group*region: F1,39.9 = 77.4, P < 0.001)
(Fig. 4). Pairwise comparison demonstrated that Graphesthesia scores
were lower at the neck in people with CNP relative to controls (M
(SD) = 11.9 (2)/20) vs. 16.2 (2)/20, P < 0.001, d = 2.2). Gra-
phesthesia was not different at the arm in people with CNP relative to
controls ((M (SD) = 17.6 (1)/20 vs. 17.6 (2)/20, P = 0.48, d = 0.0).

5. Relationship between tactile acuity clinical characteristics

There was a significant moderate positive correlation between TPD Fig. 4. Graphesthesia test scores for each group at the neck and arm. Error bars denote
measured at the neck, and both pain intensity (r = 0.48, P = 0.03) and 95% Confidence Intervals.
duration (r = 0.77, P < 0.001). There was no significant relationship
demonstrated between PTP (r = 0.05, P = 0.84) or Graphesthesia
The subgroup analysis comparing people with WAD to people with
(r = 0.06, P = 0.80) and pain intensity. There was a significant
idiopathic neck pain revealed no difference at the neck for TPD
moderate relationship demonstrated between both PTP (r = 0.62,
(MD = 7.7 mm, P = 0.054, d = 0.54), Graphesthesia (MD = 0.07,
P < 0.001) and Graphesthesia (r = 0.58, P < 0.001) and pain
P = 0.9, d = 0.06) or Point-to-point tests (MD = 0.44, P = 0.74,
duration.

64
D.S. Harvie et al.
d = 0.15).
6. Discussion
We aimed to determine whether tactile acuity is impaired in people
with CNP relative to controls, whether deficits are localised to the
painful body region, and whether deficits are proportional to duration
and intensity of pain. Our primary hypothesis was supported, in that
people with CNP had reduced tactile acuity when compared to healthy
controls at the neck regardless of measure. TPD was also impaired in
the arm and low back suggesting deficits are widespread, however these
deficits were significantly lower than at the neck. A moderate positive
correlation was found between TPD threshold pain intensity and pain
duration.
6.1. Localisation of acuity deficits
Interestingly, people with CNP demonstrated deficits in TPD at all
body sites. While deficits appeared smaller in the arm and low back
relative to the neck, they were nonetheless present. This raises the in-
triguing possibility that pain-related reduction in sensory precision is
not necessarily localised to the region of pain. Graphesthesia and PTP
deficits were localised to the neck however, which may relate to a
number of factors. For example, Graphesthesia and PTP appear to have
poorer reliability (Harvie et al., 2017), and may therefore have lower
discriminatory capability. Further, the tests may probe distinct aspects
of tactile function, which may be differentially affected by neck pain.
For example, the TPD test probes ability to differentiate between nearby
tactile inputs, rather than localizing them to an anatomical site, such as
in the PTP test. Indeed, neural processes that govern the discrimination
(or convergence) of nearby tactile inputs are likely to differ from those
that govern ability to localise tactile inputs on the body, with respect to
both central and peripheral mechanisms. Further, the non-tactile spe-
cific aspects of each test might also contribute to the somewhat dis-
crepant results. For example, since the PTP test requires one to recall
the location of touch, and accurately point to it without the use of vi-
sion, it would depend not only on tactile acuity, but also working
memory and proprioceptive function; while Graphesthesia depends on
both tactile function and cognitive processes associated with letter re-
cognition. Nonetheless, given that deficits were demonstrated in areas
beyond the painful region, the notion that deficits relate to cortical
processes has preliminary support.
6.2. Tactile acuity and clinical characteristics
Since the magnitude of cortical re-organisation appears to relate to
the severity and duration of symptoms (Flor et al., 1997; Wand et al.,
2011a; Flor, 2003; Elbert et al., 1994), we hypothesised that tactile
dysfunction would also relate to pain intensity and duration. Indeed,
TPD threshold correlated with both variables, while PTP and Gra-
phesthesia related to pain duration. However, a positive relationship
between tactile acuity deficits and pain intensity or duration is not a
consistent finding in the literature, with a recent systematic review
showing that although a correlation between pain and tactile acuity has
been demonstrated in complex regional pain syndrome (CRPS), this is
not a consistent finding in musculoskeletal pain (Catley et al., 2014).
The current study included a high proportion of participants with pain
of traumatic origin (75%), who tend to show signs of greater central
dysfunction, such as cold hyperalgesia (Scott et al., 2005), which may
explain the finding in this population.
6.3. Mechanisms of sensory imprecision
The mechanisms underlying sensory imprecision are emerging, with
evidence suggesting that imprecision or disruption in the processing of
body related information across multiple systems in people with
65
Musculoskeletal Science and Practice 33 (2018) 61–66
chronic pain (Moseley et al., 2012). A proposed conceptual framework
to make sense of these disruptions is known as the Cortical Body Matrix
paradigm – which posits a neural network that maintains the multi-
sensory representation of the body and subserves its regulation and
protection through biological, behavioural and perceptual mechanisms
(Moseley et al., 2012). The stability of such representations depends on
the presence of highly tuned neurons and effective intracortical in-
hibition (Nicolelis and Lebedev, 2009). Deficits in sensory processing
and sensory perceptions are likely to reflect disruption of sensory pro-
cessing mechanisms. How such disruptions mediate pain, however,
remains unclear. The recently proposed Imprecision Hypothesis, suggests
that imprecision leads to greater difficulty in differentiating signals of
threat and signals of safety – leading to erroneous defensive responses,
including pain (Moseley and Vlaeyen, 2015). Others have proposed that
cortical dysfunction could lead to incongruence between motor intent
and sensory feedback in such a way as to cause pain (Harris, 1999),
although evidence for this is conflicting (Moseley et al., 2006; Daenen
et al., 2012; Don et al., 2017).
6.4. Clinical relevance
This research suggests that tactile acuity deficits are associated with
CNP, which may be a sign of somatosensory reorganization within this
population. This is particularly relevant since it has been suggested that
sensory discrimination training may reverse sensory impairment and
alleviate pain (Flor et al., 2001; Pleger et al., 2005; Wand et al., 2011a;
Hohmann et al., 2012; Morone et al., 2012; Paolucci et al., 2012; Tesarz
et al., 2015; Vetrano et al., 2013; Wand et al., 2011b; Moseley et al.,
2008b). However, this study alone cannot be used as a basis for justi-
fying treatment since the efficacy of tactile training in people with neck
pain is not known. Importantly, this study has provided some evidence
that deficits may be present beyond the painful area. This is critical,
since some authors have suggested that comparing painful and non-
painful sites within an individual may be useful in identifying impair-
ment (Wand et al., 2014). Although deficits were smaller in non-painful
regions, we suggest that assessment of tactile acuity impairment may
benefit from considering normative data in addition to comparisons
between painful and non-painful areas (Lourens, 2014).
6.5. Limitations
Several limitations need to be mentioned. Firstly, we emphasise that
causative relationships cannot be inferred from these cross-sectional
data and as such, longitudinal studies are warranted to further in-
vestigate the cause/effect nature of the relationship between neck pain
and tactile acuity. Secondly, although our RA was blinded to study aims
and hypotheses, they were not blinded to group allocation. Also, in
regard to our exploration of tactile acuity deficits in WAD vs. idio-
pathic, it remains possible that a between-group difference exists that
this study was not powered to detect. Indeed, the mean difference in
TPD between the groups (7.7 mm) supports this notion, and highlights
the possibility that WAD is associated with greater tactile acuity defi-
cits. The apparent mean difference, however, may be explained by the
more severe presentation in the WAD group relative to the idiopathic
group (mean pain intensity = 51/100 vs. 27/100, mean dura-
tion = 8.5yrs vs. 4.6yrs). The apparent correlations between TPD
deficits and clinical characteristics would seem to support this notion.
Nonetheless, the possibility remains that tactile acuity function presents
differentially across subgroups of chronic neck pain, and caution in
generalising these results is advised. Future studies should also consider
the effects of medication on test outcomes. Since only three participants
in this study were taking centrally acting analgesics we were unable to
perform reasonable subgroup analyses, however, the possibility of
confounding should be considered in further studies. Indeed, the TPD
thresholds of the three individuals taking centrally analgesics
(89.9 mm, 54.8 mm and 79.5 mm) was on average 75 mm, which was
D.S. Harvie et al.
considerably higher than the mean of the whole group (64 mm).
However, we cannot say whether this tendency was a factor of random
variance, whether a causative relationship exists, or indeed whether
medication use and impaired tactile acuity are factors of a third vari-
able such as pain intensity—which was considerably elevated in these
individuals taking centrally acting analgesics. Finally, in light of recent
evidence elucidating working memory and executive function deficits
in people with chronic pain (Berryman et al., 2013, 2014) caution in the
interpretation of any test in which there is memory or cognitive load is
suggested.
7. Conclusion
This study showed that people with CNP have tactile deficits in the
neck when compared to healthy controls regardless of measure. Deficits
in TPD were also shown at non-painful sites, suggesting reduced sen-
sory precision can spread beyond the painful region. That pain duration
and pain intensity were positively related to TPD thresholds supports
the potential relevance of the finding. While the nature of the study
precludes the inference of causation, this study highlights the important
possibility that CNP is associated with somatosensory reorganization.
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